title: Epidemiology of bloodstream infections caused by Acinetobacter baumannii and impact of drug resistance to both carbapenems and ampicillin-sulbactam on clinical outcomes.
abstract: Acinetobacter baumannii has become a leading cause of bloodstream infections (BSI) in health care settings. Although the incidence of infection with carbapenem- and ampicillin-sulbactam-resistant (CASR) A. baumannii has increased, there is a scarcity of studies which investigate BSI caused by CASR A. baumannii. A retrospective cohort study was conducted on adult patients with BSI caused by A. baumannii and who were admitted to the Detroit Medical Center between January 2006 and April 2009. Medical records were queried for patients' demographics, antimicrobial exposures, comorbidities, hospital stay, and clinical outcomes. Bivariate analyses and logistic regression were employed in the study. Two hundred seventy-four patients with BSI caused by A. baumannii were included in the study: 68 (25%) caused by CASR A. baumannii and 206 (75%) caused by non-CASR A. baumannii. In multivariate analysis, factors associated with BSI caused by CASR A. baumannii included admission with a rapidly fatal condition (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.27 to 6.32, P value = 0.01) and prior use of antimicrobials (OR = 2.83, 95% CI = 1.18 to 6.78, P value = 0.02). In-hospital mortality rates for BSI caused by CASR A. baumannii were significantly higher than those for non-CASR A. baumannii-induced BSI (43% versus 20%; OR = 3.0, 95% CI = 1.60 to 5.23, P value < 0.001). However, after adjusting for potential confounders, the association between BSI caused by CASR A. baumannii and increased risk of in-hospital mortality was not significant (OR = 1.15, 95% CI = 0.51 to 2.63, P value = 0.74). This study demonstrated that CASR A. baumannii had a distinct epidemiology compared to more susceptible A. baumannii strains; however, clinical outcomes were similar for the two groups. Admission with a rapidly fatal condition was an independent predictor for both CASR A. baumannii and in-hospital mortality.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.forename: Reda A
authors.initials: RA
authors.lastname: Awali
authors.forename: Amar
authors.initials: A
authors.lastname: Krishna
authors.forename: Paul
authors.initials: P
authors.lastname: Johnson
authors.forename: Ryan
authors.initials: R
authors.lastname: Tansek
authors.forename: Khawar
authors.initials: K
authors.lastname: Chaudary
authors.forename: Paul
authors.initials: P
authors.lastname: Lephart
authors.forename: Jessica
authors.initials: J
authors.lastname: Slim
authors.forename: Jatinder
authors.initials: J
authors.lastname: Hothi
authors.forename: Harris
authors.initials: H
authors.lastname: Ahmed
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
authors.forename: Jing J
authors.initials: JJ
authors.lastname: Zhao
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000472:pathogenicity*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D013407:Sulbactam / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000667:Ampicillin; D013407:Sulbactam